Birnbaum v.Jan 29, 2004

Rafael Campo

Understanding ourselves better may be the key to getting better. A conversation with writer and physician Rafael Campo on the role literature and expression play in the healing process, and what’s being done about it.

Rafael Campo is probably the perfect dinner guest. Well-spoken, avuncular and articulate with—as you will see below—an unerring facility for completing and correctly punctuating long, expressive declarative sentences and an easy-going laugh, he doesn’t project an aura of intense poetic Sturm und Drang and gravitas but make no mistake, Campo is a poet.

Poet (Dr.) Rafael Campo was, as he facetiously points out, born in the northern part of Cuba called Elizabeth, New Jersey to Cuban exile parents. He attended Harvard Medical School, where he now practices general internal medicine as well as at Beth Israel Deaconess Medical Center. He has published a number of poetry collections, The Other Man was Me, The Desire to Heal, What the Body Told, Diva, Landscape with Human Figure, a prose collection, The Poetry of Healing, and most recently, The Healing Art: A Doctor’s Black Bag of Poetry. He has also won a number of prizes and awards, including a Guggenheim Fellowship, and his poems, essays, and reviews have appeared in many publications, including The Best American Poetry 1995, DoubleTake, The Kenyon Review, The Nation, The New York Times Magazine, The Paris Review, Parnassus, Ploughshares, and the Washington Post Book World.

The Healing Art’s central compelling thesis is that poetry has the power to heal. In illuminating his belief, Campo relies on poems by William Carlos Williams, Mark Doty, Audre Lorde, Alicia Ostriker, Marilyn Hacker, Lucia Perillo and Miroslav Holub, Tory Dent, and L.E. Sissman to investigate stages of illness, starting with our intuitions of mortality and our premonitions of illness that frequently precede our earliest symptoms. If nothing else—and there is much else—Rafael Campo’s work and poetic explications exhibit a humane approach to the practice of medicine that is more often practiced in the breech.

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Robert Birnbaum: People’s lives are complicated; from what I know about you, your life offers a fair share of complexity. When you meet new people at a party or a dinner and eventually you are asked, ‘Well, what do you do?’ what do you say?

Rafael Campo: I’d say that, ‘I’m probably first and foremost a kind of healer.’ And if they don’t run away screaming after I say that—

RB: [laughs]

RC:—then I elaborate further. I say that, ‘I’m very interested in the ways in which voice and narrative can explicate the experience of human suffering. And I look at those things—’

RB: And if they are still not running away?

RC: Then I’ll say, ‘That as this weird hybrid of physician and poet there is a real important intersection there that I feel that I am witnessing everyday in my work with patients, certainly in my work with words and language.’ So by then they have either fallen asleep or really have run away. And I move on to the next guest. [laughs].

RB: You are not bashful about revealing your self? Many writers I have talked to feel awkward in saying they are writers. In part, because it leads to a predictable and somewhat dumb dialogue. But you don’t mind—you actually have said this?

RC: I have. It’s an interesting question—with my work as a doc I speak so often that I have to be behind so many kinds of barriers and obstacles, so when I have the opportunity to really be visible to someone in a social setting, I am happy to take it. I relish this identity as a writer even though I still consider myself in some respects an imposter—I think that it’s a fun kind of drag to wear. And I am also very interested in the kinds of identities that a person can inhabit and can manifest, and as you started our conversation saying, I certainly have more than just these few that we have started on. I am really interested in how does one move between layers of being, if you will. And I think my work as a doc does reveal some of that to me—when I listen to narratives of my patients I can see how they negotiate some of their own identities in this troubled world. And so for me that is something I try to reflect back on my own writing and my work with them.

RB: I do note that you didn’t say, ‘I am a doctor and…’ You said, ‘I am a healer.’ Which is your way of synthesizing or unifying what it is you do and not compartmentalizing.

RC: I really don’t. I think of them as being inextricably intertwined. I can’t imagine doing one without the other. They are so deeply and profoundly interconnected and not just in my own experience of the work itself but also as we look back through history there are so many connections or links between expressive or performative language and therapeusis or healing in this larger sense. It’s really hard to ignore. There is a compelling relationship there that I haven’t entirely figured out and I hope perhaps that never gets totally explicated. Some of my colleagues in the biomedical world want to explain us entirely in terms of our genes and our physiology. I resist that. While I certainly see the value of this biomedical model, which is so powerful in our moment, I really still want to embody, in my own work, this ancient notion that language and how we tell the story of who we are—particularly of how we suffer—and how critically important that is as a definition of being human, of living as a human being. If some of those mysteries are taken away from us by some proteomics guru, I am going to jump out that window behind you. That’s the peril of our moment. We have become so enamored of science. There is a pill for everything. There is a pill to give us an erection. There is a pill to prevent our hair from falling out. There is a pill to help us be thinner. We seem to be on this relentless path toward defining ourselves by this scientific or biomedical, easily explicated model out there.

RB: That’s what we would expect—that doesn’t come out of nowhere. And that’s the way physicians see themselves and they are, of course, going to propagate that view. In speaking to Sherwin Nuland this last summer I became aware that bioethics is a relatively recent field of inquiry and, in fact, medical schools are starting to see that perhaps a little more emphasis might be warranted for ethical concerns.

RC: There is a kind of resistance in the profession at large. Perhaps it comes from a number of different places. One is the much-maligned managed care of this country’s attempt to control healthcare costs. Certainly, the sheer amount of scientific knowledge out there that physicians feel compelled to master leads to some of this kind of searching for alternatives. What else is there in this work that is meaningful? And then we do live in a increasingly multicultural society; people in medicine sometimes experience that also as a kind of burden, a kind of frustration. How do I talk to someone who doesn’t share my primary language, never mind my life experiences, etc.? Docs in general are frustrated. They are looking for meaning in this work.

RB: Let’s not talk about other doctors. Are you frustrated as a physician?

RC: I have my moments where I do feel a kind of frustration. But more in the sense that we haven’t as a profession really engaged some of these questions deeply enough.

RB: Your frustration is with your profession and the way it views its mission?

RC: Exactly.

RB: You said something before about what defines us as human. What is that definition of being human?

RC: I think of being human as the sum of many parts, I suppose. Our biological hardwiring, to nod somewhat to my medical colleagues, really does propel us in important ways, toward narrative, toward storytelling, toward language. We are, as far as we know, unique in this capacity for expressive language. That’s incredibly central to who we are as living beings. And, of course, we are complex, physiological organisms, constructs of biology. And this connection between those two—this idea of a mind, a soul, really, housed in this physical body is perhaps the most compelling definition of being human—for me as someone who works quite a bit with language and with the body itself.

RB: If physicians accept the physiological imperative of humans to tell stories and be embroiled in language, then wouldn’t more physicians be like you?

RC: Well, you know, this is the problem.

RB: [laughs]

RC: They are not like me. They should be more like me. Well, actually we have a problem in medicine right now. Which gets to some of those frustrations, those difficulties that I was speaking to earlier. There are perhaps two ways to go with that, when one confronts those problems and challenges. One is to retreat into this mechanized, robotic self. And really treat people as if they were Toyotas, machines that have something mechanically wrong with them. The medical training process really abets that kind of retreat. We are actually actively taught not to feel anything toward our patients.

RB: In your book, you mention that you were criticized for that.

RC: Oh yeah, many times I received that kind of feedback, which at the time I thought was the most damaging kind of feedback a young, aspiring physician could receive.

Some of my colleagues in the biomedical world want to explain us entirely in terms of our genes and our physiology. I resist that. While I certainly see the value of this biomedical model, which is so powerful in our moment, I really still want to embody, in my own work, this ancient notion that language and how we tell the story of who we are—particularly of how we suffer—and how critically important that is as a definition of being human, of living as a human being.

RB: Why would you want to be a physician if you didn’t want to care about patients?

RC: That’s a good question. Many people are attracted, in all frankness, probably by the income possibilities. I am on the admissions committee at Harvard. I see a lot of our applicants are really attracted to, again, this biomedical model, the promise that science can explain everything. And there is a kind of reassurance in that position or that promise that I think many people find irresistible. ‘Yeah, I want to know what it means to be human but I can’t look inwardly, I can’t find it in literature, I don’t have the tools or whatever it might be to draw me into that world so let’s go for the simpler answers, the equations that I can calculate, the X-ray that shows the shape of the heart. Let’s go for the CT scan that shows all the organs of the body in great detail, and then I don’t have to reflect on some of those difficult questions.’

RB: It’s a minor point—I’m of the generation that remembers that physicians actually used to make house calls. What was the fault line when that stopped being something that doctors did?

RC: I don’t know historically what the turning point was, but certainly we have been moving relentlessly toward a model of medical care that is centralized. It takes place under the doctor’s control, in the alien space of the hospital. For the patients, of course, it’s the worst place to be treated because it’s totally frightening and impossible to navigate and a lot of it has to do with a power dynamic, also. This sense of control—that doctors can control the narrative of the illness when it takes place in the hospital better than we can if it were allowed to transpire in a patient’s home, or in communities, or with their families.

RB: It’s not a narrative any longer.

RC: Right, it ceases to be a narrative. In fact it becomes an artifact to biomedical thinking. It’s extremely scripted. I think of the notes we write about patients when they come in the hospital, how the code language of medicalese really fits these individual, complex-moving stories—

RB: My favorite is the use of the verb ‘presents.’

RC: Exactly. And ‘complains of,’ ‘chief complaint’—it sounds like all patients do is kvetch all the time. It’s ridiculous. There are many examples of language that biomedicine uses as a way, as a means of control and asserting its authority over those aspects of the illness experience that, quite frankly, we can’t control. That’s where poetry, where narrative, where language really comes into its own as the indispensable instrument that it is. This moment where at the end of life, where another round of chemotherapy is just not going to do anything. Then that’s when the patient tells their story—where you hear it for the first time, if we are present. Most oncologists hightail it out of there because they don’t want to be around when someone is actually dying. Those are the moments where stories and poems have their greatest relevance to care providers and something we should pay more attention to in taking care of patients. I am really trying to find ways in which literary writing and creative self-expression can be used in medical education and certainly in patient care.

Rafael Campo, photograph by Robert Birnbaum

RB: You contrast healing with curing. Will you talk about the difference as you see it?

RC: It’s really an important distinction we often do fail to make. To my mind, healing is something that can happen even when a cure is not being grasped. For example, anecdotally, many patients of my own, people whom I have cared for, feel healed even though they ultimately are succumbing to cancer or AIDS or whatever we don’t yet have a biomedical cure for. It is an extremely important distinction for them. Around this language of biomedicine someone ‘fails’ a chemotherapy treatment, so it becomes incredibly important for someone to be able to have that possibility of being healed even in the face of failing the cure. That is, again, indispensable for patients, for family—it’s something that biomedicine finds threatening because when someone is healed, I can imagine in this metaphysical sense of the metaphysical poets that there is a way that the spirit of the human imagination goes on and if someone is remembered by family members, if someone is healed in that imaginative sense of where they go to a journal, they can go to a page and leave something written for their loved ones, there is a way that they persist in this world that challenges the notion of a cure. They may not be physically alive any longer, but imaginatively in their creation, in how they are remembered by loved ones, they certainly live on. So there is a kind of immortality there that is compelling and beautiful and tremendously heartening. So I think that distinction is a critical one.

RB: ‘Curing’ is some physician’s judgment that there is absence of abatement of disease. And ‘healing’ is a relaxation with or acceptance of whatever your lot in life is.

RC: Exactly. That’s a wonderful way of framing the difference. And of course, there is overlap. There are many people who are healed and cured and that’s wonderful. But again it’s those who can attain healing without being biomedically cured that also are the folks for whom narrative and language and this whole notion of empathy, as well, is especially important.

RB: Your background is interesting. You grew up in northern New Jersey.

RC: The northern part of Cuba known as Elizabeth, New Jersey. [both laugh]

RB: Have you ever been to Cuba?

RC: No, but I always feel like the language—and we talk about the imaginative capacity for language—is a kind of medium for return, even if I can’t be there physically.

It’s funny that part of the impulse to go to medical school was not a healing impulse but one of self-enclosure—that white coat would make me whiter. If I could master medicalese, I could pretend that Spanish wasn’t really my first language. I could be macho and tough and withstand the brutality of the medical training process. And prove that I wasn’t gay. Macho and straight. Of course that is totally ludicrous.

RB: You are clearly not the stereotypical physician. So we are back at the party where you are telling someone about your sense of who you are and what you do.

RC: [laughs]

RB: And they are still paying attention. What happens when they say, ‘Will you be my doctor?’ I mean, most people would want to have a physician like you.

RC: That’s very kind of you. Often the reaction I have, certainly when I present my work and I talk about some of these things, I don’t see it as any kind of—perhaps it’s more of a reaction away from the kind of medicine that is taking over the profession. Doctors as part of this movement away from the humane and empathy are also quite practiced in hiding themselves, obscuring their own humanness in their interactions with people they care for. My colleagues come up to me all the time and say to me. ‘How can you be so visible to your patients?’ ‘How do you feel comfortable with them knowing that you are gay?’ Or knowing whatever it is they are knowing about me that I have written about in my work. My response to that when it is a party full of doctors: ‘I think it is so important a part of my attempt to align myself as a therapeutic ally with patients to really reveal myself [to be] as just as human as they are. I have my own foibles and quirks and I am a person like any other person who has erotic desire and why should that be hidden from a patient, particularly people who are suffering?’

RB: And they, the doctors, respond, ‘Because…’

RC: ‘That’s personal information. That’s not relevant. What’s relevant is again, what does the biopsy report say, what is the sodium level, are they taking their prescriptions?’ I think it is relevant. Nothing could be more relevant. If my patients see me as equally human and just as likely as they might be to have a difficulty in a relationship or miss medication doses, that allows a kind of trust to develop that really allows me to provide even better care. With that trust comes the clue or the symptom that they might not have otherwise mentioned. There is a very practical side to this self-openness or revelation that is useful and has practical value in communicating with patients. It’s also a matter of spirit. I grew up in a family that if you weren’t laughing or crying or screaming when you said it—maybe you didn’t feel about what you were saying. Even from the literary side, I am assailed for being sentimental or confessional or those kinds of pejoratives. I trace it back to my [Cuban] culture, which is a culture of letting it hang out, the dirty laundry is out there flapping on the clothesline and you are screaming over it to make sure abeula is behaving herself.

RB: Don Lee had written a profile of you in Ploughshares and alluded to your difficulties as an adolescent because people made fun of you because you were a foreigner and a child of immigrants. How did that happen?

RC: We moved around when I was growing up. We started out in a area that was very comfortable, a community of Cubans and working-class immigrant folks. As my father’s career trajectory developed, we moved from that environment into a much more white, upper-middle-class environment. That’s where the troubles began, where I really started to feel the fractures of difference. Another reason why poetry and literary writing is so valuable, even in this moment, is because of the ways in which it helped me to reach out and repair those kinds of fractures of difference that I felt, particularly during my adolescence. And then to some extent self-imposed in college and medical school, where I decided I wanted to be white and straight and not different. I actively and quite consciously pursued a whole life plan that would wall off those aspects of difference that I wasn’t quite well-prepared enough to integrate into my life when I was thinking about who I would I be in this world. And those years are sad and dark years for me. [chuckles] It’s funny that part of the impulse to go to medical school was not a healing impulse but one of self-enclosure—that white coat would make me whiter. If I could master medicalese, I could pretend that Spanish wasn’t really my first language. I could be macho and tough and withstand the brutality of the medical training process. And prove that I wasn’t gay. Macho and straight. Of course that is totally ludicrous. [laughs] It was ridiculous that I could have even thought some of those things. Actually, it was listening to the narratives of my patients and particularly during the first HIV/AIDS crisis in this country that really awakened me to what I was doing and how wrongheaded I was. I really am grateful to so many of the people I took care of, who actually helped me in ways that I hope to try to reflect back to people I take care of now.

RB: You said first wave.

RC: In the sense that we have become terribly complacent about the epidemic and we in our particular political moment in this country are not only isolating ourselves from the rest of the world, where there are about 42 million people living with HIV infection, most of whom will die within the next decade without the kinds of treatments we are so fortunate to have here. And within our own country there is an epidemic among poor women, Latinos, African Americans, substance users—people who are in our most vulnerable societal groups. No one seems to care. We are tired on some level of the epidemic—it’s been a grueling two decades of terrible ravages. By the same token, the notions that we have found a cure again—I have patients saying it to me everyday, ‘Well, if I get HIV, it’s not the end of the world. We have a cure, right?’ I have to remind them we don’t. We have medications that can control the infection.

RB: Why is so little attention paid to diabetes?

RC: HIV and AIDS happen at some of these intersections of identity that are so charged that I think they illuminate some of the issues around suffering in a particular way that an illness like diabetes perhaps can’t. Partly the fact that HIV/AIDS is sexually transmitted—a disease that is still a terminal diagnosis, and affects by categories that are more explicit, that are more visible, than other illnesses do. If we look closely at diseases like diabetes and cancer and heart disease, we shouldn’t be surprised that there are actually similar disparities in terms of how people do with their illnesses depending what social groups they are part of.

RB: I see the money tossed at heart disease and cancer but someone quoted me the research grant money from the National Institute of Health for diabetes and it was nearly nothing. Really next to nothing.

RC: You can get into a debate about which is the worst disease, which is the one that is more insidious or more terrible. That’s another place where literary writing and poetry can be very useful. When one reads poems about the experience of cancer or multiple sclerosis or HIV infection, you come to see once again that what is universal about all of us and about all diseases is how we suffer. The fact that we do suffer is perhaps the most critical issue that we can think of we when we think of how we can address a disease in our moment. HIV/AIDS was a particularly, the moment was which the epidemic occurred—

RB: Affecting the highly visible fashion and art worlds?

RC: Exactly, so it was partly who it affected and the organs of our culture that were attacked by it and also the first disease in a long time that posed a threat to our biomedical model. We are on the threshold of curing cancer. We have the tools to protect us and yet here is this disease that was killing thousand and thousands of people—this postmodern killer. That threw a kind of wrench in the biomedical relentless progress against disease.

I still, sadly, encounter a lot of interview reports where it says, ‘Good MCAT, for an underrepresented minority.’

RB: There were people who believed that AIDS victims deserved their fate.

RC: There is that impulse as well. I see connected to the hubris of the biomedical model, ‘Well, if you are going to comport yourself outside the boundaries of what we consider to be healthy, salubrious behavior, then you deserve what you get. Sorry, we can’t help you.’ The whole notion of silence equals death—that is to me a profound articulation of how important our language is to our survival. HIV became a kind of metaphor—Sontag’s essay—how certain groups in our culture can become silenced quite literally and also at the same time how language can be an effective antidote to that marginalization or erasure. That was another reason why HIV/AIDS, because it provoked a whole group of people who had really been largely silenced and marginalized in the culture to speak out—silenced in complex ways. Many gay men in particular were quite active in cultural production in this country and yet their own individual narratives as gay people, as boundary-crossers in other ways, were not visible. So there was this kind of paradox, what parts of this creative soul could be seen? And HIV demanded that people come out and speak out and fight the disease—some of those militaristic terms that Sontag also frowns on.

RB: There is the paradox that perhaps this health crisis hastened the integration of gayness and otherness or whatever progress there has been, into the mainstream.

RC: I agree.

RB: That aside, you are on the admissions committee at Harvard Medical School—

RC: [chuckles]

RB: Do you represent the left wing of humanity on that august body?

RC: I am as about as far out—[laughs]

RB: I am trying to picture what those meetings might be like. Do you meet as a body?

RC: We meet in subcommittee and then in larger groups as well. I do feel myself to be rather on the extreme fringe of my colleagues on the committee.

RB: Do you get re-appointed?

RC: One is re-appointed on a regular basis and it is complex and I have somehow managed to maintain my foothold.

RB: Is it like the Supreme Court—a token Black, a woman, a Jew?

RC: [laughs] Sometimes I feel, to credit Harvard to some extent, we are really as an institution—and particularly since our dean came on, Joe Martin—we are examining some of the issues of diversity on campus, and it is well-recognized how poorly represented certain groups are in the medical profession. Harvard is really doing something and has been for some time to try to make some of these traditionally underrepresented groups more visible in the profession. So I have to give them credit there. We are working on it. I still, sadly, encounter a lot of interview reports where it says, ‘Good MCAT, for an underrepresented minority.’

RB: If you allow for good intentions, what holds these institutions back?

RC: There is an incredible inertia from—at Harvard—a couple of centuries of a singular way of existing and doing things. Where we really need to increase our efforts is at the other ends of the spectrum, the high-school and even before high-school level—to ensure kids from marginalized groups can imagine that they actually can become physicians or for that matter other kinds of professions, if they so desire. Also at the level of the faculty where we have to support and nourish the careers of academicians who are from these various groups because there is nothing more chilling, from my own experience of being at Harvard Medical School, of not seeing a person of color or for that matter a woman lecturing classes. It was very isolating, just something as simple as that. It sounds too simplistic but really that was difficult. In fact, part of what attracted me to medicine was the desire for the kind of experience where I could erase my own ethnicity and sexuality, but then, of course, when I finally got to medical school I realized how important and nourishing that would have been to have more of that kind of presence and that kind of mentoring. So we have hope for the future. [laughs]

RB: Let’s take a little turn here. I am wondering about the six or seven examples of poems that you use to illustrate the healing aspects of poetry—are those poems and poets that you are particularly fond of, or it was just that they were most useful?

RC: Each poet whose work appears in The Healing Art is a poet with whom I have become intimately and deeply engaged.

RB: Even William Carlos Williams?

RC: Even Williams, who presents more challenges for me the more I immerse myself in his work and some of his striking opinions about certain issues. But that’s a whole other story. So yes, these are poets whose work I really am very deeply interested in and have been for quite some time and in some cases poets I actually know personally, and so that kind of connection to the work really, I hope, helped me to better explicate some of the poems in terms that weren’t entirely dry literary criticism terms, but really fleshier, meatier, almost imperfectly analyzed—in the way that I encounter them and work with them—and certainly the way my patients encounter them, who aren’t literary readers, for the most part.

RB: Why—you have expressed a strong sense of identity with your Cuban heritage—were there no citations of Cuban writers and poets?

RC: I certainly think of [Jose] Marti as a singular poet, a singular voice from Latin America.

RB: I don’t remember your quoting him.

RC: I allude briefly to being read Marti’s poems by my folks, growing up, and how those poems really are touchstone and home and homeland in the realm of poetry. I was also looking for poems that really did very explicitly take on illness experience in one way or another and that’s why I didn’t have any of his poems.

RC: He certainly did. He wrote poems about his own illness experience and much of his poetry I think of as more allegorically related to illness experience. He has poems that imagine the voyage to the leper colony, poems that are very all—

RB: But not as graphically related to your own thesis in The Healing Art?

RC: Exactly, and these are poems that I wanted to be representative of illness that lay readers would recognize, that are of our moment and I could have written a book that was 500 pages long—

RB: [laughs]

RC: But I have a very strict editor. [Elaine Mason at WW Norton]

RB: Does Norton publish an inordinate amount of poetry?

RC: They have a wonderful poetry list and they are one of our last bastions of truly literary publishing in this country. Their commitment to publishing poetry in the world of diminishing interest in the poem—sadly for us as a culture—is really heroic, and I applaud them for it.

RB: It is heroic. There is the idea afoot that more people write poetry than read it.

RC: I can’t imagine a world without poems. I talk about this in The Healing Art. One of the reasons I wrote the book was to enact how poetry can have relevance in a life that isn’t necessarily a life about poetry exclusively. I am not only a poet. I don’t support myself writing poems or teaching poetry. So I think that was a real motivation to get this book out for the world—to say poetry matters. Dana Gioia’s famous essay of 10 years ago that was recently updated, poetry does absolutely matter, must matter to anyone who is concerned with healing and in certainly in many other professions and walks of life. Poetry is indispensable.

RB: Might it be a positive sign if the curriculum at Harvard included a course by a Rafael Campo on healing and poetry?

RC: As matter of fact, I am teaching a course this coming semester on that very topic at Harvard Medical School. Sort a of six-year uphill battle in getting it through the curriculum committee

RB: Wow!

RC: But there it is and I am really excited about it. There are many reasons to be hopeful in the medical profession. At medical schools across the country there are programs now being developed to introduce—

RB: And deroboticize?

RC: Exactly. There is a relatively new discipline called ‘Medical Humanities’ that is coming into its moment now. Largely in response to the pressures we were talking about. So many doctors are really feeling adrift and exasperated and frustrated and looking for meaning again in their work as physicians. It turns out that literary writing is a wonderful way to be reminded of those earliest impulses toward healing.

I have allowed myself on some level by being a voice for empathy in my day-to-day work as a physician I find perhaps I have suppressed some very important anger, and anger can coexist with empathy and compassion. They need not be mutually exclusive, in the ways I had recently assumed they must be kept separate.

RB: There is not exactly an epidemic of physicians reaching for literature—Ethan Canin [who completed medical school but does not practice], Daniel Mason—

RC: There are a few of us who are really actively publishing and actively engaged in clinical work—Jerome Groopman here in Boston.

RB: He only seems to write specifically on medical matters.

RC: Right, he doesn’t go outside the realm of medicine. You are right, probably most of the examples I can think of are folks who really more or less exclusively their experiences as physicians.

RB: Sherwin Nuland writes about medical matters, though he did just publish a biography of some 19th-century epidemiologist.

RC: There is Richard Selzer. Robin Cook and Michael Crichton. Who else? Perri Klass, a pediatrician here in Boston. Jack Coulehan who is writing on Chekhov. He has a new book on Chekhov coming out and is also a poet.

RB: Is there a literary physicians association?

RC: We are such a small world, we encounter ourselves on the same settings or the same syllabi. Same bookstores and same readings. So we run into each other a lot. Maybe it’s a sad commentary on the lack—there should be more of us. I do find when I go and share my work there is a tremendous number of aspiring doctor writers. That also says something about the profession even as we seem to be on this trajectory away from the humane, that there is something there about those stories we hear from our patients is irresistible and compelling and fundamentally human.

RB: Could you write prose other than the essays?

RC: I have mixed feelings about prose. I think I’m a poet at heart, and many long hours of the iambic heartbeat through my stethoscope, that ebb and flow of breathing, there is a magnetism about that that draws me to poem making. My first book of essays was more lyrical than prosaic but qualifies as a book of essays. I do have another book of prose in the works. I do have a novel that is 10 years in the writing—something I continually suppress because I just feel I don’t know if I want to have an identity as a fiction writer. I have so many identities already. [laughs] One more would push me over the edge. I go back and forth with that. One of these days—

RB: Is it also a real-world concern—writing poetry can be done in fits and starts, written on the run?

RC: I think you are right. What does happen—it’s sort of a right-brain activity. Some of the musical and sonic dimensions can happen when one is actively engaged in other language of narrative—the back and forth of interaction with patients. So that’s not to say I am not focusing on my clinical work, but I definitely have the experience of incubating in that way. When I do have 10 minutes at midnight before I pass out, the poem has been shaped by those currents of thought. Also, my experience of writing is peculiar in that I do find that some of the pressures of being a doctor do sort of wring the poems out of me.

RB: If you had more time?

RC: I might not write as much. Maybe that would be a good thing in the eyes of my critics. [laughs]

RB: You think critics would want you not to write? What would they do? Critics don’t want to silence anyone except some few really terrible writers.

RC: I know. I am always the first to thank my critics for pointing out things to me in my own work, so I shouldn’t be perverse in talking about criticism. And I have done a fair share myself.

RB: Who can really graciously accept criticism? Do you harbor anger within yourself? I remember reading a poem as an undergraduate by César Vallejo, which included a lot of shaking the fist towards the heavens—

RC: I have been immersing myself in the new collection of [Pablo] Neruda that has just been published. I have been reacquainting myself with my own anger because I am angry [laughs]. I have allowed myself on some level by being a voice for empathy in my day-to-day work as a physician I find perhaps I have suppressed some very important anger, and anger can coexist with empathy and compassion. They need not be mutually exclusive, in the ways I had recently assumed they must be kept separate. I don’t know if it’s fair, in our discussion, to enter into the realm of politics.

RB: Let’s risk it.

RC: The political situation in this country is absolutely dispiriting and more than a source of anger for me.

RB: I am selling tickets on the boat that will be taking all the disaffected writers I have talked to, away from the home of the brave.

RC: Let’s go to Cuba, maybe Canada. We are in a kind of crisis. As someone who is very concerned with empathy, I find this really horrifying. Our leaders are playing on our fears in ways that are incredibly damaging to our sense of who we are as a people, as Americans. When one thinks of what this country stands for—what it stood for in the eyes of my parents, who came here with their hopes and dreams, and to see it twisted in this way and that we are becoming arrogant and mistrustful and intolerant of others. Not willing to engage in the kind of meaningful discourse that even in literary circles is becoming increasingly deadened because of these attitudes.

RB: I read an essay by Curtis White and he talked of teaching a class and having a student who was Chilean who spoke to the class about the fact that he was very impressed by the decency and generosity of Americans and also their ignorance of what was being perpetrated in their name around the world.

RC: Our leaders, instead of leading us in compassion and leading us in empathy and mutual understanding and peace—we are being pushed in this other direction. I know the kind of reception my own family had here. Our country is really [being] stolen from us. I don’t know where the opposition to that process is. We seem to be so fragmented in our opposition to what is happening and I don’t know how—in some way or another we will come together to reject this worldview and this view of each other, this very divisive view. I don’t know. The poem is perhaps one place that could happen—as you say, maybe more people are writing it than reading it. But other forms of literary discourse seem to be shrinking. I don’t know how we can have this conversation anymore.

RB: Maybe it is self-important and silly, but there is a lot of action on the Internet. Which self-reflexively points to Internet activity as evidence of this being a transformative moment. So perhaps new media is a pathway.